Anxiety & Depression

Anxiety Disorders Defined

Anxiety is a normal biological reaction to stress and can serve to warn a person when action is needed. However, anxiety that is severe, persistent, and uncontrollable can interfere with daily activities of living and may indicate that a person is dealing with an anxiety disorder.

Anxiety disorders often fill an individual’s life with overwhelming anxiety and fear. It is different than the mild and brief anxiety that is caused by a stressful event. An anxiety disorder can grow progressively worse if not treated. The term “anxiety disorder” refers to Generalized Anxiety Disorder (GAD), Panic Disorder (Panic Attacks), Social Anxiety Disorder (Social Phobia), Specific Phobia, and Agoraphobia. Anxiety disorders, as a group, are the most common mental health condition in America. It often has a biological basis and can be linked to family history but it also can be related to childhood trauma, Post-Traumatic Stress Disorder (PTSD), and stressful life situations or losses.

Generalized anxiety disorder (GAD) refers to constant, exaggerated worrisome thoughts and tension about everyday routine life events and activities, in which the symptoms last at least 6 months. It can be accompanied by physical symptoms such as fatigue, muscle tension, or headaches. Panic disorder refers to repeated episodes of intense fear that strikes often and without warning. There is an onset of physical symptoms that peak within a short period of time including, chest pain, heart palpitations, shortness of breath, abdominal distress, feelings of unreality, and fear of dying. As mentioned above, anxiety can also be present when an individual has a history of trauma. Part of the biphasic response to trauma triggers is hyperarousal in which a person may exhibit an anxiety reaction. Many people with an anxiety disorder may also experience periods of depression.

Similar to the treatment of depression, psychotherapy and at times, medication, is the treatment path for anxiety disorders. Cognitive behavioral therapy (CBT), Expressive Art Therapy, and Trauma work (if indicated) are the clinical basis for which I work with individuals dealing with anxiety or anxiety disorders. From a CBT perspective, it can be helpful to develop relaxation skills and/or a meditation practice along with altering anxious cognitive distortions that perpetuate an anxiety state.

Expressive Art Therapy can also be useful in navigating anxiety issues. One essential benefit of art therapy is that it can help regulate and calm the nervous system. It can also provide a visual expression of a situation which can then serve to provide containment and allow for a different perspective. Some of the art directives might involve creating a visual anchor to bring one’s attention to the present moment and shift from anxiety to calm. Another example is creating a collage of calm and safety to then use the images to induce self-regulation and reduce anxiety in the body.

Anxiety Resources

The Anxiety & Phobia Workbook by Edmund Bourne
The Complete CBT Guide for Anxiety by Lee Brosan, Peter Cooper, & Roz Shafran
The Cognitive Behavioral Workbook for Anxiety: A Step-by-Step Program by William Knaus
Art Therapy – The Science of Happiness: Overcome Stress, Depression and Anxiety Using the Power of Music, Dance, Writing and Drawing by Paul Catalani

Depression Defined

Depression may be referred to as a low mood with an aversion to activity. There is a pervasive loss of energy and a loss of interest in pleasurable activities (clinical term is called anhedonia). It is a condition in which a person feels discouraged, sad, hopeless, and disinterested in life in general.

It is an illness that involves the body, mood, and thoughts and causes pain for the person with the disorder and those who care about the person. As noted in Unveiling Depression in Women by Archibald Hart, PhD and Catherine Weber Hart, PhD, “While depression may be limited to mood changes, it is considered a whole person disorder since the body, mind, emotions, relationships, and spirituality are all affected.”

With depression there may be a sense of despair about one’s situation. It may also be accompanied by feelings of irritability. There may be anger that is turned inward to manifest as depression. It can become difficult to function and complete everyday tasks. There is a feeling of being weighed down and burdened. There is a lack of joy.
When the feelings last for more than two weeks and interfere with daily activities then it is likely to be what is called a Major Depressive Episode. It is not a sign of personal weakness and a person with depression can’t simply “pull themselves together” to get better. It is not uncommon for someone with depression to also suffer from anxiety and vice versa. Unprocessed anger can also manifest as depression. Some individuals have one episode in their lifetime and others have recurring episodes. Once you have a major depressive episode an individual is at high risk to have another episode. Depression is, however, highly treatable and so there is hope.

There are risk factors for depression such as a family history of depression, early developmental struggles, chronic stress, poverty, chronic illness or medical conditions, chemical imbalances, major losses, childhood trauma, and other psychosocial stressors such as divorce. There is a connection between childhood trauma and depression in adulthood. Loss in adulthood also has the potential to trigger depression. If there are unmourned losses from one’s past this can complicate the grieving process and give way to depression.

Depression comes in different forms; three of the most common include Major Depressive Episode, Dysthymia, and Bipolar Depression.

The symptoms of Major Depression are delineated in the DSM (Diagnostic Statistical Manual) and include the following (only 5 are needed for a two-week period to meet the diagnostic criteria for this disorder):

Depressed mood most of the day, nearly every day for 2 weeks

Diminished interest in pleasurable activities

Significant weight loss or weight gain

Insomnia or hypersomnia

Psychomotor agitation or retardation (feelings of restlessness or being slowed down)

Fatigue or loss of energy

Feelings of worthlessness or inappropriate guilt

Diminished ability to think or concentrate; or indecisiveness

Recurrent thoughts of death or suicidal ideation

To be classified as Major Depression, the above listed symptoms cause significant distress for the individual or impairment in social & occupational functioning.

Dysthymia, also called Persistent Depressive Disorder, involves long-term (two years or longer) less severe symptoms that do not disable, but keep one from functioning normally or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.

Bipolar Disorder, once called Manic-Depression, is characterized by a mood cycle that shifts from severe highs (mania) or mild highs (hypomania) to severe lows (depression). During the manic phase, a person may experience abnormal or excessive elation, irritability, a decreased need for sleep, grandiose notions, increased talking, racing thoughts, increased sexual desire, markedly increased energy, poor judgment, and inappropriate social behavior. During the depressive phase, a person experiences the same symptoms as would a sufferer of major depression. Mood swings from manic to depressive are often gradual, although occasionally they can occur abruptly.

Treatment for Depression

Psychotherapy, and sometimes psychopharmacology (medication) is the recommended treatment for depression. One of the primary evidenced-based practices is Cognitive Behavioral Therapy (CBT). This modality is based on the premise that one’s thoughts affect one’s feelings and behaviors. It assumes that altering maladaptive thoughts and beliefs bring about changes in affect and behavior. Interventions are aimed at automatic thoughts and behaviors to alleviate symptoms of depression. It may involve activity scheduling, a thought record (to capture automatic thoughts or cognitive distortions) and working to change negative core beliefs about oneself.
In addition to CBT, art therapy can be a powerful means through which the root of the depression is explored with an avenue to release the symptoms keeping one stuck. The creative art making process can also be healing in and of itself. This can be an option when ‘words do not speak’ as it provides an alternative language to communicate feelings and inner experiences.

Moreover, as depression can be a trauma related condition, I approach it from this perspective as well integrating a psychodynamic approach. Sometimes there are unmourned losses from childhood that need to be processed in order to move forward in a healthy way. Other times depression becomes an automatic response to life’s trials. As the whole person is impacted by depression, the treatment needs to take into account all aspects of a person’s life; applying a whole-person approach to recovery. In my practice for the treatment of depression, I incorporate CBT, Expressive Art therapy, and Psychodynamic principles.